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Internal Medicine

Urethral meatal stenosis

Change in the elliptical shape of the meatal opening to a circular shape because of fibrosis or scarring, with visually apparent narrowing.

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Aetiology

Long-term complication of circumcision (20% circumcision cases)

  • Risk of MS in non-circumcised boys is 10–26 times lower than circumcised boys)

Pathophysiology

In the absence of the foreskin, the meatus is exposed to mechanical and chemical irritation from ammoniacal diaper (nappy) that produces blister formation and ulceration of the urethral opening, which eventually gives rise to meatal stenosis (a narrowing of the opening).


Clinical features

  • Abnormal strength & direction of urinary stream
  • Visible narrow opening at the meatus in boys
  • Irritation, scarring or swelling of the meatus in boys
  • Dysuria and frequency
  • Incontinence (day or night)
  • Hematuria at end of urination
  • Urinary tract infections – increased susceptibility due to stricture

Management

  • Meatal dilation under local anaesthesia
  • Meatotomy with general/local anaesthesia

 

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